What to Know About Breakthrough Pain

Breakthrough pain is sudden, intense, and short-lasting in people with chronic medical conditions. Chronic conditions last more than one year and often require long-term medical care—including ongoing pain management with medication. Sometimes, a flare-up occurs, and pain "breaks through" your medication.

This article discusses breakthrough pain—what it is, whom it usually affects, possible causes or triggers, and treatment options.

What Is Breakthrough Pain?

There are various types of pain. Acute pain most often occurs immediately after an injury. It is usually intense but typically improves as the injury heals.

Chronic pain is pain that has been present for at least three months. It can come on gradually or quickly, and ranges in severity. Chronic pain is common in long-standing medical conditions, such as cancer or arthritis. Healthcare providers often prescribe long-term pain medications to manage chronic pain.

Despite ongoing medications, pain from chronic conditions can still arise at times—this type of pain is called breakthrough pain. Breakthrough pain can have a trigger or occur randomly.

Other characteristics of breakthrough pain can include:

• Sudden onset
• Stronger intensity than the ongoing chronic pain
• Pain that lasts for a few minutes or up to an hour
• Pain usually (but not always) occurring in the same part of the body as the chronic pain

Causes and Triggers for Breakthrough Pain

Breakthrough pain can occur for various reasons, though the reason isn't always known. Sometimes movements, such as coughing, using the toilet, walking, or swallowing, can trigger breakthrough pain. It can also occur from spasms of internal organs, such as the intestines.

Breakthrough pain can be due to procedures and treatments used to treat chronic illnesses. Examples include:

• Chemotherapy
• Radiation
• Diagnostic tests
• Surgery

The side effects of the underlying chronic medical condition can also cause breakthrough pain. These side effects include:

• Constipation
• Headaches
• Emotional stress
• Skin rash

Breakthrough Pain Medication

Drugs used to treat breakthrough pain are sometimes called rescue medications. These drugs are typically fast-acting and short-lasting and are designed to treat the characteristics of breakthrough pain.

Medications for Breakthrough Pain Relief

Tylenol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful for mild breakthrough pain. Over-the-counter (OTC, not requiring a prescription) NSAIDs include:

• Advil or Motrin (ibuprofen)
• Aleve (naproxen)
• Bayer (aspirin)

In some cases, a healthcare provider may recommend prescription-strength anti-inflammatory medications for pain management, such as:

• Celebrex (celecoxib)
• Voltaren (diclofenac)
• Orudis (ketoprofen)
• Ketorolac (clonidine)

Opioids are the most common type of medication prescribed for moderate to severe breakthrough pain. Examples include:

• MSIR (morphine)
• Codeine
• Suboxone (buprenorphine)
• Percocet (oxycodone)
• Dolophine (methadone)
• Vicodin (hydrocodone)
• Actiq or Fentora (fentanyl)
• Dilaudid (hydromorphone)
• Ultram (tramadol)
• Nucynta (tapentadol)
  

Other Treatment Methods for Breakthrough Pain

Other nondrug interventions can be helpful for treating breakthrough pain. Examples include:

• Acupuncture
• Physical therapy
• Massage therapy
• Stress management and relaxation techniques
• Psychotherapy or counseling
• Hypnosis
• Support groups
• Gentle exercise (such as walking, yoga, or tai chi)
• Medical marijuana
• Heat or cold

Potential Complications and Outlook for People With Breakthrough Pain

If breakthrough pain is not adequately treated, it can significantly impact your quality of life. Eventually, it can also lead to physical disability and make activities of daily living difficult.

You don't have to live with your current level of pain. Talk to a healthcare provider about your pain to learn of available treatment options. Consider seeing a physical therapist for advice regarding assistive devices that can help improve your mobility or an occupational therapist for advice about adaptive equipment to make daily tasks easier.

Summary

Breakthrough pain occurs in people living with chronic medical conditions. These individuals typically take medications that manage their baseline pain. However, sometimes pain can still break through current treatment. Triggers for breakthrough pain include certain movements, illness, testing procedures, or surgery. Sometimes, it occurs without an apparent reason.

Breakthrough pain can be treated with over-the-counter medications or prescription opioids. Other interventions, such as physical therapy, massage therapy, gentle exercise, stress management techniques, and psychotherapy, can also be helpful.